Seeking input regarding medical insurance/dr. office issue

[Higherarky]

Hi Friends.

A little over a year ago my audiologist supplied me with a pair of hearing-assist devices (my third pair in +/-10years). The office staff had contacted my insurance company for pre-approval for the nearly $5000 cost of the devices. The office staff claimed the insurance company approved the entire cost of the devices; no deductable, no co-pay.

This morning, dr. office staff called and claimed that the insurance company changed their mind and only paid for one device, only half the pre-approved reimbursement.

The dr. office staff is now billing me for the other $2500.

I feel like the insurance co. thinks I am only worthy of hearing out of one ear. I feel like sending one device back to the dr. office and telling them I cannot afford it, or sending the dr. office $1 a month for 2500 months.

Most of all, I feel like this is fraudulent. If the dr. office had told me up front I'd have to pay $2500, I would have had the option to agree or decline. Now I am left with no option but to pay the $2500, and I feel like I have been cheated and conned into paying the $2500.

Do I have any options? Is this fraud? If so, what are my options? I truly don't have $2500 to throw around.

Thanks for reading. I look forward to your helpful input.

[Lochloosa]

1. Call your insurance provider and ask them.

If what the Dr said is true file a protest and send a copy to the Dr explaining you are not paying till it's resolved.

[Higherarky]

4. Thank you. I will pursue the issue.

[wryter2000]

2. Does your state have an insurance commissioner or similar position?

We have one in CA. I'd be on the phone to that office.

I agree with the other person. Call your insurance provider directly. You might also ask the dr's staff if they got any proof of the initial approval. If that's written down somewhere, you want to get it.

[Higherarky]

5. Thank you.

[Lochloosa]

7. I agree with the recommendation on the insurance commissioner.

They helped me out years ago with an issue.

[Raven123]

3. Makes no sense. There should be documented interactions - dates, maybe times and hopefully names

Some insurance companies record phone interactions. Might want to check. Also I would ask for a record of all communication between the audiologist office and the insurance company. There should be a document trail.

Never had experience with hearing aids, but I have with an immunization that was denied coverage. I received a letter from the insurance company.

On what basis did this “change of mind” take place. You need to find out that answer.

You may need to contact both the insurer and the audiologist yourself to verify what interactions took place. It’s a shame to have to do this, but you have no choice.

[Higherarky]

6. Thank you.